(4) Treatment of collagen disease. An example of a collagen disease is
systemic lupus erythematosus. Manifestations of collagen disease are well controlled
by glucocorticoids that help to decrease morbidity and prolong survival time.
Prednisone, 80 to 120 milligrams, is given orally for two to three weeks in the treatment
of these conditions.
(5) Treatment of allergic disease. Glucocorticoids suppress manifestations
of allergic disease, they inhibit inflammation and antibody production.
(6) Treatment of bronchial asthma. Hydrocortisone may be administered to
patients with bronchial asthma in order to provide them with dramatic relief. However,
the use of hydrocortisone is usually reserved for patients who have not been responsive
to other anti-asthmatic drugs due to the side effects associated with glucocorticoid
(7) Treatment of various skin disorders. Many patients with noninfective
skin disorders (such as allergic, inflammatory, or pruritic dermatosis) experience
remarkable relief of symptoms with topical use of steroids. Topical use of these drugs is
of benefit in severe sunburn, nonvenomous insect bites, and self-limiting cutaneous
conditions such as eczema.
(8) Treatment of malignancies. Glucocorticoids are used in conjunction with
other chemotherapeutic agents in the treatment of acute lymphocytic leukemia and
lumphomas because of their anti-lymphocytic effect.
(9) Treatment of septic shock. The use of corticosteroids in septic shock
has been adopted by most physicians and is used in very large doses early in the
treatment of shock. Their beneficial effect appears to be related primarily to their action
on cellular membranes. That is, they decrease the patient's reaction to septic,
endotoxin, or hemorrhagic shock.
9-10. ADVERSE EFFECTS ASSOCIATED WITH GLUCOCORTICOID THERAPY
As with any medication, patients taking glucocorticoids should anticipate certain
adverse effects. The likelihood of such adverse effects correlates with the dose of the
drug and the duration of therapy, the age and condition of the patient, and the
underlying disease. This paragraph will focus on the common adverse effects
associated with glucocorticoid therapy.
a. Peptic Ulceration. The glucocorticoids are said to produce peptic ulceration
by interfering with tissue repair, decreasing the protection provided by the gastric mucus
barrier, and increasing gastric acid and pepsinogen production. Physicians do not all
agree that glucocorticoid therapy causes peptic ulcers. However, they do agree that
glucocorticoid therapy can hide the symptoms of peptic ulcers so that ulceration or
bleeding can occur without warning pains. Some physicians prescribe antacids in
hopes of reducing the likelihood of peptic ulcers in patients on glucocorticoid therapy. It